Obesity Hypoventilation

Syndrome
Obesity hypoventilation syndrome
(OHS), can be a serious, but treatable,
complication of being obese.
What is Obesity Hypoventilation
Syndrome (OHS)?
OHS is a breathing disorder in obese people that
leads to low oxygen levels and too much carbon
dioxide in your blood. Low oxygen and high
carbon dioxide levels may develop because of
a condition called hypoventilation during the
day (daytime hypoventilation). Hypoventilation
means you are not moving enough air in and out
of your lungs very well. With OHS, you may also
have difficulty sleeping because of obstructive
sleep apnea (see ATS Patient Series to read more
about Obstructive Sleep Apnea at http://patients.
thoracic.org/information-series/index.php). The
three main characteristics of OHS are: 1) obesity;
2) daytime hypoventilation (difficulty getting
rid of carbon dioxide); and 3) sleep disordered
breathing (such as obstructive sleep apnea).
OHS is also referred to as Pickwickian syndrome
because persons with OHS may have symptoms
like those described by Charles Dickens in his
essay, The Posthumous Papers of the Pickwick Club.

short periods of time. These may be concerning

to your bed partner. Your bed partner may be
the only one who sees or hears your nighttime
symptoms.

Why is it important to know if I have

Obesity Hypoventilation Syndrome?
It is important to know if you have OHS because
OHS can be treated. If left untreated, OHS is
potentially life threatening. When treated, your
breathlessness, fatigue, daytime sleepiness, and
depression may be reduced or relieved entirely.
Treatment could improve your quality of life and
decrease your chances of further health issues,
including the need to be hospitalized from serious
complications of having OHS. If left untreated,
the lack of oxygen can put a strain on your heart
(see ATS Patient Series on Obstructive Sleep Apnea
and Heart Disease at http://patients.thoracic.org/
information-series/en/resources/osa.pdf).

What are the symptoms of Obesity

Hypoventilation Syndrome?
The symptoms of OHS are usually caused by a
lack of sleep and a lower than normal oxygen
level in your blood. Symptoms can include
daytime sleepiness, lack of energy, breathlessness
(see ATS Patient Series on Breathlessness at http://
patients.thoracic.org/information-series/en/
resources/ATS_Patient_Ed_Breathlessness.pdf),
headache and even depression.

Do we know what causes Obesity

Hypoventilation Syndrome besides obesity?
The cause (or causes) of OHS are not fully
understood. OHS may be a combination of your
brains being unable to correctly manage your
breathing, your excess fat producing hormones
that cause you to breathe ineffectively and the
extra weight placed on your chest that makes it
much more difficult for you to breathe normally.

Nighttime symptoms include: loud and frequent

snoring during sleep and/or breathing pauses.
Breathing pauses are when you stop breathing for

How is Obesity Hypoventilation

Syndrome diagnosed?
Your health care provider diagnoses your OHS

Am J Respir Crit Care Med, Vol. 189, P15-P16, 2014.

ATS Patient EducationSeries 2014 American Thoracic Society

www.thoracic.org

by taking a complete history of your symptoms,

including your sleeping habits, evaluating your
body mass index (BMI), measuring your oxygen
and carbon dioxide levels, possibly taking a chest
x-ray and a sleep study. Your height and weight
are used to calculate your BMI. A BMI of 30 or
over is considered obese. An online calculator
for BMI is available at http://www.nhlbi.nih.
gov/guidelines/obesity/BMI/bmicalc.htm. Your
oxygen and carbon dioxide levels are measured by
taking a blood sample from your artery, usually
from an artery in your wrist. A pulse oximeter (a
sensor lightly attached to the finger) can be used
to get an estimate of the amount of oxygen (but
not carbon dioxide) in the blood (see ATS Patient
Series Pulse Oximetry at http://patients.thoracic.
org/information-series/en/resources/ats-patiented-pulse-oximetry.pdf). Pulse oximetry however
is not as accurate as a blood sample from your
artery.
A chest x-ray may be taken to rule out any
other causes of your breathing difficulty. You
may be asked to have a sleep study called a
polysomnography (see ATS Patient Series on Sleep
Studies at http://patients.thoracic.org/informationseries/en/resources/sleep-studies.pdf). The sleep
study will determine if you have sleep apnea and
what treatment may be needed. Although not
necessary to diagnose OHS, a sleep study is usually
ordered for patients with OHS to also find out
how severe your sleep apnea may be. In addition,
a sleep study is done (titration polysomnography)
to guide treatment.

How is Obesity Hypoventilation

Syndrome treated?
Treatment for OHS will include weight loss and
treating your breathing disorder. Sometimes,
weight loss alone corrects many of the other
problems such as obstructive sleep apnea.
Therefore, the first approach to treating your OHS
is weight loss. Diet, exercise, and good sleep are
important to weight loss. Because OHS can cause
serious health problems, sometimes surgery is
needed (e.g. gastric bypass surgery) to help with
your weight loss.

probably need positive-airway pressure (PAP)

support described in the ATS Patient Series on
Obstructive Sleep Apnea in Adults. The types of
PAP support include Continuous PAP (CPAP) or
Bi-level PAP (BPAP). Both are devices that deliver
air to you through a mask that you wear anytime
you are sleeping or napping. CPAP delivers air
at a constant pressure both when you breathe in
and when you breathe out. BPAP on the other
hand delivers higher pressures when you are
breathing in, than when you are breathing out.
When OSA is severe, and not controlled with
PAP, a tracheostomy (surgical hole in the neck)
may be needed to ensure that your sleep apnea is
adequately treated.
Research is being done to find medications
to treat OHS. So far, no medications are
recommended for the treatment of OHS.
Authors: Vidya Krishnan MD, MHS and Pedro Genta MD
Reviewers: Suzanne Lareau RN, MS; Bonnie Fahy, RN, MN, CNS;
Atul Malhotra MD

Action Steps

4 If you are obese and having symptoms of OHS,

discuss this with your health care provider who
may refer you to a Sleep Specialist.
4 Weight loss alone may help your OHS, but your
breathing pattern while sleeping must also be
controlled.
4 If your bed partner notices you have pauses in your
breathing, contact your health care provider
Doctors Office Telephone:

Resources:
National Institutes of Health:
http://www.ncbi.nlm.nih.gov/pubmedhealth/
PMH0001149/#adam_000085.disease.causes
Patient.co.uk:
http://www.patient.co.uk/doctor/PickwickianSyndrome.htm

To treat your breathing disorder, you will

The ATS Patient Information Series is a public service of the American Thoracic Society and its journal, the AJRCCM. The information appearing
in this series is for educational purposes only and should not be used as a substitute for the medical advice one ones personal health care
provider. For further information about this series, contact J.Corn at jcorn@thoracic.org.
www.thoracic.org